

<div class="main clearfix">
    
    <div class="box clearfix bottom30">
    <?php if(!empty($error)) { ?>
        <div class="pad10">
            <div class="err_log txt-left mag-btt10">
                <p style="color: red" class="clf60 s14"><strong>Thông báo:</strong> <?php echo $error;?></p>
            </div>
        </div>
        <?php } ?>
        <form action="<?php echo Url::createUrl("addPaymentConfirm/index") ?>" method="get" name="form1">
            <ul class="form4">
                <li class="clearfix"><label><strong>ID Tài khoản </strong>:</label>
                    <div class="filltext">
                        <input type="text" name="userId" style="width:180px" value=""> 
                    </div>
                </li>
                <li class="clearfix"><label><strong>Số tiền </strong>:</label>
                    <div class="filltext">
                        <input type="text" name="money" style="width:180px" value=""> 
                    </div>
                </li>
                <li class="clearfix"><label><strong>Họ và tên </strong>:</label>
                    <div class="filltext">
                        <input type="text" name="full_name" style="width:180px" value=""> 
                    </div>
                </li>
                <li class="clearfix"><label><strong>Ngày sinh </strong>:</label>
                    <div class="filltext">
                        <?php
                            $this->widget(
                            "zii.widgets.jui.CJuiDatePicker"
                            , array(
                            "name"=>"birthday"
                            , "id"=>"birthday"
                            , "value"=>$birthday                                                                
                            , "options"=> array(
                            'showAnim' => 'fold'
                            , 'dateFormat' => 'dd-mm-yy'
                            , 'changeYear' => 'true'
                            , 'changeMonth' => 'true'
                            , 'showOn' => 'both'
                            , 'buttonText' => '<input type="button" name="" value="" class="ic-date">'
                            )
                            , 'htmlOptions' => array(
                            'style' => 'width:170px'
                            , 'class' => 'form'
                            )
                            )
                            );
                        ?>                                        
                    </div>
                </li>
                <li class="clearfix"><label><strong>Địa chỉ </strong>:</label>
                    <div class="filltext">
                        <input type="text" name="address" style="width:180px" value=""> 
                    </div>
                </li>
                <li class="clearfix"><label><strong>CMT </strong>:</label>
                    <div class="filltext">
                        <input type="text" name="identity_number" style="width:180px" value=""> 
                    </div>
                </li>
                <li class="clearfix"><label><strong>Di động </strong>:</label>
                    <div class="filltext">
                        <input type="text" name="mobile" style="width:180px" value=""> 
                    </div>
                </li>
                <li class="clearfix"><label><strong>Email </strong>:</label>
                    <div class="filltext">
                        <input type="text" name="email" style="width:180px" value=""> 
                    </div>
                </li>
                <li class="clearfix"><label><strong>Wap </strong>:</label>
                    <div class="filltext">
                        <input type="text" name="wap" style="width:180px" value=""> 
                    </div>
                </li>

                <li class="clearfix"><label><strong>Ghi chú </strong>:</label>
                    <div class="filltext">
                        <input type="text" name="introtext" style="width:180px" value=""> 
                    </div>
                </li>
                <li class="clearfix"><label><strong>Kiểu thanh toán </strong>:</label>
                    <div class="filltext">
                        <select onchange="toggleOptions()" style="width:203px;" name="type">
                            <option value="1"> ATM </option>
                            <option value="2"> Thẻ điện thoại </option>
                            <option value="3"> Gửi qua bưu điện </option>
                        </select>
                    </div>
                </li>

                <li id="account_owner" class="clearfix"><label><strong>Chủ tài khoản </strong>:</label>
                    <div class="filltext">
                        <input type="text" name="account_owner" style="width:180px" value=""> 
                    </div>
                </li>
                <li id="account_number" class="clearfix"><label><strong>Số tài khoản </strong>:</label>
                    <div class="filltext">
                        <input type="text" name="account_number" style="width:180px" value=""> 
                    </div>
                </li>
                <li id="account_bank" class="clearfix"><label><strong>Ngân hàng </strong>:</label>
                    <div class="filltext">
                        <input type="text" name="account_bank" style="width:180px" value=""> 
                    </div>
                </li>
                <li id="account_branch" class="clearfix"><label><strong>Chi nhánh </strong>:</label>
                    <div class="filltext">
                        <input type="text" name="account_branch" style="width:180px" value=""> 
                    </div>
                </li>
                <li id="mobile_receive" class="clearfix" style="display: none;"><label><strong>Điện thoại thông báo</strong>:</label>
                    <div class="filltext">
                        <input type="text" name="mobile_receive" style="width:180px" value=""> 
                    </div>
                </li>

                <li class="clearfix"><label><strong>Thời gian </strong>:</label>

                    <div class="filltext">
                        <select name="month">
                            <?php for($i=1;$i<=12;$i++){ ?>
                                <option value="<?php echo $i?>"><?php echo $i; ?></option>
                                <?php } ?>
                        </select>

                        <select name="year">
                            <?php for($i=date('Y');$i>=2011;$i--){ ?>
                                <option value="<?php echo $i; ?>"><?php echo $i ?></option>
                                <?php } ?>
                        </select>
                    </div>

                </li>

                <li class="clearfix"><label>&nbsp;</label>
                    <div class="filltext">
                        <input type="submit" class="btn-bigblue" value=" Thêm mới "> 
                    </div>
                </li>

            </ul>
        </form>
    </div>
</div>
<script type="">
    function toggleOptions(){
        var e = document.form1.type.value ;
        if(e==1){
            $("#account_owner").show("slow");  
            $("#account_number").show("slow");  
            $("#account_bank").show("slow");  
            $("#account_branch").show("slow");  
            $("#mobile_receive").hide("slow");  
        }else if(e==2){
            $("#account_owner").hide("slow");  
            $("#account_number").hide("slow");  
            $("#account_bank").hide("slow");  
            $("#account_branch").hide("slow");  
            $("#mobile_receive").show("slow");
        } else if(e==3){
            $("#account_owner").hide("slow");  
            $("#account_number").hide("slow");  
            $("#account_bank").hide("slow");  
            $("#account_branch").hide("slow");  
            $("#mobile_receive").hide("slow");
        } 
    }
</script>                 